NDT Advance Access originally published online on August 2, 2005
Nephrology Dialysis Transplantation 2005 20(11):2511-2516; doi:10.1093/ndt/gfi041
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Resistive index and chronic allograft nephropathy evaluated in protocol biopsies as predictors of graft outcome
Departments of 1 Nephrology, 2 Radiology and 3 Pathology, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, L'Hospitalet, 08907 Barcelona, Spain
Correspondence and offprint requests to: Daniel Serón Micas, MD, Nephrology Department, Hospital Universitari Bellvitge, C/Feixa Llarga s/n, L'Hospitalet, 08907 Barcelona, Spain. Email: 17664dsm{at}comb.es
Introduction. The presence of chronic allograft nephropathy (CAN) in protocol biopsies is negatively associated with graft survival. Although recent studies have indicated that the resistive index (RI) is a predictor of graft failure, it does not correlate with CAN in stable grafts. We therefore studied the relationship between RI and CAN and examined the predictive value of both parameters on graft outcome.
Methods. Included were patients transplanted between 1997 and 2002 and who had protocol biopsies and RI determinations. Renal lesions were blindly evaluated according to Banff 97 criteria. Mean glomerular volume, cortical interstitial volume fraction and intimal arterial volume fraction were estimated using a point counting technique. RI was determined before biopsy in at least two different renal locations. The outcome variable was defined as graft failure or a 30% serum creatinine increase between protocol biopsy and last follow-up.
Results. Eighty-seven patients were included. RI correlated with recipient age (R = 0.52, P<0.0001), diastolic blood pressure (R = –0.36, P = 0.0006), pulse pressure index (R = 0.27, P = 0.009) and g-score for histological glomerulitis (
= 0.30, P = 0.0054), but there were no correlations between RI and chronic Banff scores or any morphometric parameter. The presence of CAN (relative risk, 3.5; 95% confidence interval 1.2–10.2; P = 0.02) but not RI was associated with the outcome variable.
Conclusion. RI was associated with surrogate measures of vascular compliance such as recipient age and pulse pressure index but not with chronic allograft damage, even when it was evaluated by histomorphometry. Our results indicate that histology may be superior to RI in predicting graft function deterioration, at least in patients with stable renal function.
Keywords: chronic allograft nephropathy; protocol biopsies; renal transplantion; resistive index
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